93% is the average of cases where patients did not qualify for braces. Ranging from 39% to 100% of records checked so far.

$154,000,000 in general dentistry of probable fraud

55% is the average of overutilization - billing fraud; overtreatment. Ranging from 25% by some providers to 99% by other providers.

Office of Inspector General & TMHP

August 2008 audit of TMHP revealed problems

2011 was follow-up on 2008 audit

12 investigation in 2011

108 so far in 2012

Time needed to complete an investigation

4 years in 2011

8 weeks by end of 2012

How do the new DMO's (MCNA & DentaQuest) in Texas negotiate to enroll providers?

Individual dentists - if the own their own clinic

Management, i.e. NCDR, LLC and CSHM - in the case of group practices.

TSBDE cases turned over to district attorneys

200 in 10 years - of individuals practicing dentistry without a license

3rd degree felony

5 convicted and jail time

if acted upon, most have plea agreements and board is not notified

Curbing illegal corporate practice of dentistry and patient shopping

DentaQuest - Cease and Desist Letters

Texas State Board Dental Examiners (TSBDE) -

Forward to AG's office for investigation

Could but have not sent Cease and Desist Letters.

Look if someone is working for a non-dentist owner and take action against that dentist

Non-dentist may not influence or attempt to influnce a dentist in treatment, doing so is practicing dentistry without a license.

i.e. Doug Brown - Kool Smiles

i.e. David Wilson - Small Smiles

i.e. Stephen Thorne - Pacific Dental

i.e. Michael Dell – Affordable Dental

Have had cases where dentist being investigating said he or she was influenced by a Office Manager or other employee of a DSO.

5 dentists reported such in last 2 years

Took action against the dentist

# of Dental Practices or Dental Management Organizations

Unknown by TSBDE

Acronyms for illegal operating dental management companies

DSO – Dental Service Organization

DMSO – Dental Management Service Organizations

NDOE – Non Dentist own entities

Indicator of fraud

Billboards offering Free Braces

OIG re: Jail Time:

There will be, and there are, and it’s a parade of horrors. We don’t see the end of the parade but we are going to make sure that every body that participated in the parade gets to be evaluated to see if we can criminally prosecute them. We’re going to make sure that if there’s an ability to recover under the Texas Medicaid Fraud Prevention Act we will pursue that.

We are coordinating with the Office of Inspector General through our task force, if we find that the quickest way to get resolution and recover the money from them is to go through the Office of the Inspector General processes, through SOA, we will do that. So we are trying to attempt to anything and everything to facilitate the quickest resolution and get the state of Texas money that has been stolen from it, back.